Provider Demographics
NPI:1669629572
Name:GOLDBERG, JEREMY S (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:S
Last Name:GOLDBERG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 N ARLINGTON HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-4824
Mailing Address - Country:US
Mailing Address - Phone:847-392-6610
Mailing Address - Fax:847-394-4189
Practice Address - Street 1:1420 N ARLINGTON HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-4824
Practice Address - Country:US
Practice Address - Phone:847-392-6610
Practice Address - Fax:847-394-4189
Is Sole Proprietor?:No
Enumeration Date:2008-08-21
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19A1604122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist